Explore Availity's Collection of CMS Mandate Solutions
When it comes to preparing your health plan for CMS 0057-F compliance, there's more than meets the eye.
With solutions across the CMS 0057-f mandate, Availity is your trusted partner for managing the complexity beneath the surface
As a health plan, ensuring you meet these mandates—ranging from implementing FHIR® APIs to improving data exchange across providers and payers—is crucial.
Critical Deadlines
Health plans must meet key deadlines to ensure compliance with the CMS 0057-F rule. The most pressing deadline is January 1, 2027, by which impacted payers must implement and maintain FHIR® APIs for patient access, provider access, and payer-to-payer data exchange. Missing these deadlines could lead to financial penalties and operational disruptions, making it essential to act now and stay ahead.
Prior Authorization Process
Simplifying and accelerating the prior authorization process is a key focus of CMS 0057-F. Health plans are required to implement a Prior Authorization API that supports faster decision-making, clear communication of approvals or denials, and enhanced transparency. By refining this process, health plans can reduce administrative burden and improve patient care outcomes.
API Integration Requirements
CMS 0057-F mandates the implementation of several FHIR® APIs to improve data interoperability and streamline processes. This includes the Patient Access API, Provider Access API, Payer-to-Payer API, and Prior Authorization API. Health plans need to ensure these APIs are integrated into their systems seamlessly to support data exchange and improve care coordination across providers and payers.
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